Anxiety: its role in the history of psychiatric epidemiology.
BACKGROUND
The role played by anxiety in the history of psychiatric epidemiology has not been well recognized. Such lack of understanding retarded the incremental growth of psychiatric research in general populations. It seems useful to look back on this history while deliberations are being carried out about how anxiety will be presented in DSM-V.


METHODS
Drawing on the literature and our own research, we examined work that was carried out during and after the Second World War by a Research Branch of the United States War Department, by the Stirling County Study, and by the Midtown Manhattan Study. The differential influences of Meyerian psychobiology and Freudian psychoanalysis are noted.


RESULTS
The instruments developed in the early epidemiologic endeavors used questions about nervousness, palpitations, sweating, trembling, shortness of breath, upset stomach, etc. These symptoms are important features of what the clinical literature called 'manifest', 'free-floating' or 'chronic anxiety'. A useful descriptive name is 'autonomic anxiety'.


CONCLUSIONS
Although not focusing on specific circumstances as in Panic and Phobic disorders, a non-specific form of autonomic anxiety is a common, disabling and usually chronic disorder that received empirical verification in studies of several community populations. It is suggested that two types of general anxiety may need to be recognized, one dominated by excessive worry and feelings of stress, as in the current DSM-IV definition of Generalized Anxiety Disorder (GAD), and another emphasizing frequent unexplainable autonomic fearfulness, as in the early epidemiologic studies.
Murphy
J M
JM
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. murphy.jane@mgh.harvard.edu
Leighton
A H
AH
D001008:Anxiety Disorders / Q000266:history*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D049673:History, 20th Century; D006801:Humans; D011581:Psychological Tests / Q000266:history*; D011602:Psychophysiologic Disorders / Q000266:history*; D014481:United States